As Conditions Worsen in Humanitarian Crises, Aid Workers Also Feel the Pain

An Ebola survivor, left, puts on protective gear to work with other Ebola patients on their psychological care in Conakry, the capital of Guinea, 2014. Demands on humanitarian workers in fragile countries are skyrocketing. GRAG DeHART

The images of refugees washing up, living or dying, on the southern shores of Europe leave no humanitarians unmoved. Behind those images and others from Asia, Africa and Latin America are scores of mostly unseen relief and aid workers whose efforts to meet crises are being squeezed to the point of triage. Militants have put large areas out of bounds, resources are thin and adherence to the rules of humanitarian law are in “a downward spiral,” a leader among nongovernment organizations said, summarizing a new world of need.

The components of this world of misery are numerous. The largest movement of refugees since World War II is occurring from the tormented Middle East to the shores of the Bay of Bengal, where Burmese ethnic Muslims are under attack. Adding to these flows of desperate people are economic migrants from poor countries where pressures of rapid population growth, a dearth of jobs and dwindling agricultural land affected by climate change have led to flight. And then there is the uncontrolled violence in everyday life.

On Jan. 11, the United States Peace Corps withdrew its volunteers from El Salvador because violent street gangs had made neighborhoods unsafe, even for those dedicated to working with disaffected young men. Peace Corps volunteers were withdrawn from Honduras in 2012, again because of unsafe conditions. In El Salvador, the Peace Corps had been working off and on since 1962; in 1992, the United Nations had played a major role in negotiating a peace agreement to settle a civil war.

Samuel Worthington is chief executive officer of InterAction, a Washington, D.C.-based alliance of more than 180 nongovernment organizations operating globally to assist poor and vulnerable people. Humanitarian work is now “a tale of two worlds,” he said in a telephone interview with PassBlue.

“One is a place where we are seeing improvements in infant mortality, more girls in school, better access to water, improvements in governance, stronger emerging countries and economies and the general improvement in the quality of the life of many of the extreme poor,” he said. “In those environments, NGOs are working — almost always in partnership with governments and very often in a partnership with governments and the private sector — from building health systems, to helping a government access populations that are more marginalized, to helping companies change their values so that they have a more positive social impact.

“That’s the world we hear about when the United Nations talks about the Sustainable Development Goals and the significant progress that humanity has made as we close the Millennium Development Goals,” he said.

“Then there is this other world,” he said. “It’s a world where the nation-state is fragile; oftentimes the government is part of the problem. There are endemic conflicts, leading to degrees of lawlessness, banditry, to all-out war. In these environments, even despite all the investment of lives and treasure of the United States and other countries, we have yet to really figure out how to improve long-term human well-being; to enable better governance and advance a development agenda. The reaction of the world to this is that the very least we can do is try to address some of the humanitarian concerns while political solutions are being explored.”

Worthington said that nongovernment organizations, or NGOs, want to work in both these worlds, where government is a partner and where the nation-state is not functioning. “Demands on NGOs in fragile states are skyrocketing,” Worthington said, adding that in the recent Ebola epidemic in West Africa, for example, “organizations whose primary mission was not running treatment centers found themselves playing that role or burying bodies.”

Nongovernment organizations are reorganizing how they work in some cases, he said. “In fragile environments, the change that has happened is that the NGOs themselves have managed risk by going local. Their staffing is from the region, the infrastructure they built is supported by and in very close partnership with local institutions. A lot of vetting happens on who can and cannot work in these fragile environments.”

A positive result of NGOs hiring local people is that the growing professional skills and deep commitment among local aid and development staff members have strengthened the capacity and reach of nongovernment organizations — not only in their vicinity but also internationally.

Worthington has agonized over the moral issues surrounding aid work.

“There is a marked spiral to the bottom when it comes to paying attention to international humanitarian law,” he said. Threatened if not gone in some places, such as Syria, is “the idea of a neutral party able to tend to the wounded, get foodstuffs in for isolated or blockaded groups.”

Even the UN has pulled back from conflict zones for security concerns, he said. “We end up having a complete disregard on the side of Daesh [ISIL] or other armed groups and the increasing disregard — whether it’s Russia or Saudi Arabia — of other belligerents in the conflict.

“The US military has maintained sort of the gold standard in terms of doing what they can to play by these rules,” Worthington said, noting the exception of Kunduz, in Afghanistan, where the US said it had accidentally bombed a hospital run by Doctors Without Borders. “But the general environment is that of squeezing humanitarian space.”

Nongovernment organizations have widely agreed for decades that they do not want military protection.

“The NGO response is to go more local, not to hide behind the gun or to militarize things, but rather to rely on word of mouth, and when possible to talk with everyone [including armed groups]. This gets tricky, given the US antiterror laws, which get in the way. There have been circumstances where we wanted to ask the militants things. In the Somalia famine, it took a number of months before it became clear that having to operate in al Shabaab areas would not lead to a risk with the US government before we actually went in.”

The pressures on NGOS are mounting, Worthington said. “Even as an enormous amount of effort and capacity in [fragile and troubled] areas, the problem is getting bigger. The challenge is overwhelming the infrastructure. The available resources are now at the point where we’re starting to do triage. You began to see some of this when the WFP [World Food Program] started running out of food in the camps for refugees around Syria. You’re trading off resources in the Central African Republic to Yemen, to Syria, and there simply aren’t enough resources to go around.”

Dwindling resources do not always refer to cash, Worthington said. “It’s also about capacity, and while there’s sometimes a surplus of capacity showing up in natural disasters, you can count on two hands the number of NGOs who operate in Yemen, the Central African Republic or inside Syria. It becomes a very limited number with the actual capacity to function — the number of people they can field, language, knowing the local context, the ability to manage a large operation — and then the degree to which there are local partners who are interested in humanitarian work and are willing to take the risks to be involved. Every year, we read out the names of the 20 to 40 individuals who have been killed.

“The reality is, the marginal of places where you get no coverage at all are increasing,” Worthington said. “We always have a broad number of crises. The challenge comes when they get radicalized or if ideology is so strong, either on the government side or on the rebel groups’ side, to the point where civilian life is viewed as dispensable. This dehumanization of war is something that, unfortunately, makes this century the century where the world will continue to need its NGOs.”

Nongovernment organizations are learning what they can promise to do and what they cannot, he added. He said that the case of Haiti after the 2010 earthquake, when outsiders promised to “build back better,” was an example.

“One of the realities in the 21st century is there is compassion across borders and people show up with backpacks to help. When we count the $822 million of US NGO money that went into Haiti, 93 percent of that was for 15 organizations. One can look at all the thousands of people showing up, or one can concentrate, as in this case, on the 30 or 40 organizations that knew what they were doing.

“And even in that case,” he said, “what they promised that they could do — rebuild hundreds of schools, ensure that there’s access to clean water, staff all the cholera clinics, manage camps and rebuild thousands of houses” was in the end not doable.

“You don’t have the capacity of local governance, you don’t have power over land distribution and land title, you’re not affecting local corruption and you are only remotely influencing the larger development projects for changing Haiti,” he said. “The vision was a good one, but it needs to be understood as a 20-30 year process, not what you could do in five years.”

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Barbara Crossette is the senior consulting editor and writer for PassBlue and the United Nations correspondent for The Nation. She is also a board member of the Carnegie Council for Ethics in International Affairs and a member of the Council on Foreign Relations. She is a contribtor to the Oxford Handbook on the United Nations.

Previously, Crossette was the UN bureau chief for The New York Times from 1994 to 2001 and before that its chief correspondent in Southeast Asia and South Asia. She is the author of "So Close to Heaven: The Vanishing Buddhist Kingdoms of the Himalayas," "The Great Hill Stations of Asia" and a Foreign Policy Association study, "India Changes Course," in the Foreign Policy Association's "Great Decisions 2015."

Crossette won the George Polk award for her coverage in India of the assassination of Rajiv Gandhi in 1991 and the 2010 Shorenstein Prize for her writing on Asia.